2. NIM : _________________________________________________________
3. PRODI : _________________________________________________________
4. FAKULTAS : _________________________________________________________
6. AGAMA : _________________________________________________________
9. ALAMAT : _________________________________________________________
2. PEKERJAWAN : _________________________________________________________
Catatan:
Formulir dikirim melalui email : surat@uim-makassar.ac.id. dan disimpan untuk digunakan saat
pengambilan sertifikat PPMB 2021
Makassar, .....................2021
Mahasiswa,
(.....................................)